Hemobilia como causa infrecuente y grave de hemorragia digestiva alta / Hemobilia as a rare and serious cause of upper gastrointestinal bleeding

Introducción: La hemobilia es por definición una causa de hemorragia digestiva alta, donde existe una comunicación de la vía biliar en cualquiera de sus segmentos con vasos sanguíneos que desembocan a través de la ampolla de Vater. Su presentación es infrecuente y no sospechada en la práctica clínica diaria de gastroenterólogos, cirujanos, hepatólogos, clínicos e intensivistas, con un difícil manejo diagnóstico-terapéutico y una elevada morbi-mortalidad. Objetivo: Describir tres casos de pacientes con diagnóstico de hemobilia. Desarrollo: Se presentan tres casos con hemobilia que tuvieron una elevada mortalidad y con diferente etiología; en el primer caso por trombosis de la arteria hepática postrasplante hepático, el segundo secundario a un colangiocarcinoma de la unión hepatocística y el tercero con diagnóstico de un aneurisma de la arteria hepática derecha confirmado y parcialmente tratado por angiotomografía, posteriormente intervenido quirúrgicamente y único sobreviviente. Conclusiones: Resultaron tres casos con hemobilia de diferentes causas, con una elevada mortalidad por la intensidad de la hemorragia digestiva alta y las comorbilidades asociadas, además de señalar que ninguno de ellos presentó la tríada clásica reportada por Quincke(AU)

Introduction: Hemobilia is, by definition, a cause of upper gastrointestinal bleeding, where there is a communication of the bile duct in any of its segments with blood vessels that flow through the ampulla of Vater. It is rare and it is not suspected in the daily clinical practice of gastroenterologists, surgeons, hepatologists, clinicians and intensivists, hence the diagnostic-therapeutic management is difficult and it has high morbidity and mortality. Objective: To report three cases of patients with a diagnosis of hemobilia. Case report: We report three cases of hemobilia of high mortality and different etiology. The first case had post-liver transplantation hepatic artery thrombosis, the second had asecondary cholangiocarcinoma of the hepatocystic junction and the third had diagnosis of confirmed right hepatic artery aneurysm partially treated by CT angiography, subsequently operated on and the only survivor. Conclusions: These three hemobilia cases had different causes, and high mortality due to the intensity of the upper gastrointestinal bleeding and the associated comorbidities, in addition to noting that none of them exhibited the classic triad reported by Quincke(AU)

A Surgical Case of Residual Axillary Artery Aneurysm Associated with Kawasaki Disease / 日本心臓血管外科学会雑誌

<p>We herein report on a case in which we conducted bypass surgery for occlusion of a left axillary artery aneurysm with ischemic symptoms 21 years after the contraction of Kawasaki disease and achieved symptomatic improvement. The case involved a 22-year-old man who had been suffering from Kawasaki disease since the age of one. He had been undergoing antiplatelet therapy for bilateral axillary artery aneurysms by orally taking aspirin for 20 years. He suffered from symptoms of upper limb ischemia 21 years after receiving a diagnosis of peripheral aneurysms and occlusion of a left axillary artery aneurysm upon 3DCTA. We conducted aneurysmotomy, plication, and bypass surgery between the axillary and brachial arteries via the autologous vein. Pathological examination revealed due to the formation of atheroma in the tunica intima and disarrangement of the layer structure in the tunica media : thickening of the tunica media was partially observed. His fatigue upon exertion of his left upper extremity remarkably improved following surgery. Although peripheral aneurysms associated with Kawasaki disease are rare, as seen in this case, peripheral arterial disease remains and progresses even after long periods of time. It is believed necessary to carry out long term follow-up and examine the approaches to therapy including surgery in accordance with the site and degree of the disease.</p>

Rupture of Posterior Tibial Artery Aneurysm in a Patient with von Recklinghausen's Disease / 日本心臓血管外科学会雑誌

A 53-year-old woman with von Recklinghausen's disease was admitted with severe pain and acute right leg swelling. The physical examination revealed neurofibromas and café-au-lait spots, typical of patients with von Recklinghausen's disease. Computed tomography and ultrasonography showed a rupture of a posterior tibial artery pseudoaneurysm. Since her complaint of pain was severe and because of the rapid progression of pseudoaneurysm, we performed an emergency operation. Under general anesthesia with the pneumatic tourniquet technique, both of the proximal and distal sides of the posterior tibial artery were ligated, and the pseudoaneurysm was resected. The postoperative course was uneventful. She was given an ambulatory discharge 26 days after operation. Histological examination revealed spindle-shaped cells infiltrating the aneurysmal wall. We diagnosed this is a vascular lesion of von Recklinghausen's disease.

Autodestrucción espontánea de una malformación arteriovenosa cerebral / Spontaneous self-destruction of a cerebral arteriovenous malformation

Se presenta una paciente que fue investigada y operada en el Hospital Universitario Gral Calixto García, portadora de una malformación arteriovenosa cerebral, que desapareció espontáneamente después de un cuadro neurológico de intensa gravedad. Arteriográficamente se comprobó que estaba asociada a un aneurisma arterial en su mismo sistema vascular cerebral. La paciente había sufrido 3 eventos neurológicos en orden ascendente de gravedad, y fue el último motivo de ingreso en la Unidad de Terapia Intensiva, con un nivel de 5 en la escala de Glasgow para el coma y sin signos meníngeos evidenciables. La lesión valorada como malformación arteriovenosa cerebral en las tomografías axiales cumputarizadas previas, no se evidenció en la panangiografía cerebral realizada en la fase de mejoría clínica relativa después de su etapa más crítica. Dicha angiografía demostró un aneurisma arterial homolateral a la malformación arteriovenosa ya desaparecida, el cual fue excluido de la circulación por presillamiento de su cuello sin eventos transoperatorios ni posoperatorios relevantes. Se realiza una revisión de la literatura al respecto(AU)

Authors present the case of a patient researched and operated on in the General Calixto García University Hospital presenting with a cerebral arteriovenous malformation disappeared spontaneously after a neurologic picture of intense severity. From the arteriographic point of view it was verified that it was associated with an arterial aneurysm present in her same cerebral vascular system. The patient has had three neurological events in rising order of severity which was the last reason for admission in the Intensive Therapy Unit (ITU) with a level of 5 in the Glasgow scale for the coma and without obvious meningeal signs. The injury classified as a cerebral arteriovenous malformation according to the previous computerized axial tomographies was not evidenced in the cerebral panangiograpy carried out in the clinical phase improvement after its more critical stage. Such angiography demonstrated the presence of a arterial aneurysm homolateral to the already disappeared arteriovenous malformation, which was excluded of the circulation by means of stitching of neck without transoperative and postoperative significant events. In this respect, author made a literature review(AU)

Aneurisma verdadeiro de artéria plantar medial: relato de caso / True aneurysm of medial plantar artery: case report

Os aneurismas periféricos merecem atenção pela sua baixa frequência e associação com outros aneurismas arteriais, principalmente o de aorta abdominal. O aneurisma de artéria plantar verdadeiro é ainda mais raro. A escassa literatura disponível concentra-se nos casos de pseudoaneurisma pós-traumático dessa artéria. Relata-se o caso de uma paciente do sexo feminino, 85 anos, com queixa de dor no pé direito ao deambular durante um ano, acompanhada de nódulo pulsátil em região plantar, próximo da base do primeiro pododáctilo. Não havia história prévia de trauma ou cirurgia na região plantar acometida. Realizou-se ecografia vascular e angiorressonância, que diagnosticaram aneurisma de artéria plantar. A paciente foi então submetida à aneurismectomia com ligadura das artérias nutricionais, apresentando boa evolução pós- operatória.

Peripheral aneurysms deserve attention because of their low frequency and potential association with other aneurysms, especially of the abdominal aorta. The true aneurysm of the plantar artery is even less frequent. The literature available is scarce and focuses on cases of post-traumatic arterial pseudoaneurysms. In this paper, we report the case of an 85-year-old female patient with a one-year history of pain on the right foot when walking associated with a pulsatile tumor in the plantar region at the base of the big toe. The patient had no history of trauma or foot surgery. Vascular ultrasonography and MR angiography showed a plantar artery aneurysm. Aneurysmectomy with ligation of the medial plantar artery was performed. The patient had a good postoperative course.

Arteriomegaly with Multiple Aneurysms / 日本心臓血管外科学会雑誌

We report a rare case of surgical treatment of arteriomegaly with multiple aneurysms. The patient was a 76-year-old man who was suffering from swelling, pain, and numbness of his left lower extremity. Three-dimensional computed tomography (3D-CT) revealed arteriomegaly from the left external iliac artery to the popliteal artery with ruptured superior gluteal arterial aneurysm and superficial femoral aneurysm, and with unruptured external iliac aneurysm and popliteal aneurysm. We performed left external iliac artery—posterior tibial artery bypass, exclusion of superior gluteal aneurysm, and resection of three other aneurysms. Because of arteriomegaly, back flow from the dilated arterial branches was considerable, and the femoral artery was expanded with tension despite of distal and proxymal clamp. We therefore divided the femoral artery to avoid development of a aneurysm. The postoperative course was uneventful and 3D-CT showed good bypass flow and thrombotic occlusion of the residual femoral artery.

Expression of destrin in vessel wall tissue of traumatic arterial aneurysm and study of its clinical relativity / 中国矫形外科杂志

[Objective]To investigate the expression of protein destrin in cytoskeleton protein in traumatic arterial aneurysm(TAA) vessel wall tissue and its relationship with clinical representations and pathological characteristics.[Method]Western-blot analysis and RT-PCR were used to detect the quantitative expression of destrin protein in 13 patients with TAA and in the femoral arterial tissues of 8 normal subjects.The difference of protein expression was compared,and the results with clinical data were analyzed statistically.The correlation of unbalanced expression of destrin protein with the clinical presentations was studied.[Result] The expression of destrin in TAA tissue was lower than that in the femoral artery of normal subjects(P

Concurrent Intracranial and Extracranial Arterial Aneurysms: Report of Three Cases

Systemic multiple aneurysms are rare, and an association between intracranial and visceral arterial or abdominal aortic aneurysm in the same patient is a very rare occurrence. We report herein three such cases. In one case, aneurysms of the right internal carotid artery(ICA) and the right middle cerevral arterial bifurcation(MCAB) coexisted with the inferior pancreaticoduodenal arterial pseudoaneurysm and two ileal arterial aneurysms. In another case, the patient had the A-com arterial aneurysm and the right renal arterial aneurysm. And in the other patient, he had the right vertebral artery dissecting aneurysm with the abdominal aortic aneurym. Initially, all patients were referred to our hospital with subarachnoid hemorrhage(SAH), and thereafter first two patients developed visceral arterial aneurysm rupture in the course of hospital stay and in the last patient, the abdominal aortic aneurysm was detected incidentally during carotid angiogram for Guglielmi detachable coil(GDC) embolization of vertebral dissecting aneurym. After thorough review of our cases together with pertinent literatures, we emphasize the possibility of underlying extracranial aneurysms in ruptured intracranial arterial aneurysm patient and it's uncommon but fatal complication.

A case of Bdhcet's disease presented with recurrent, multiple arterial aneurysms / 대한내과학회지

Bdhcet's disease is a systemic vasculitis with a variety of clinical manifestations and occasionally involves arterial and venous system. The vascular involvement occurs in approximately 7~35% of patients with Bdhcet's disease and classified into venous thrombosis, arterial thrombosis and arterial aneurysm. The aneurysmal formation is more common than occlusion, though the two may coexist. Arterial aneurysm has been reported in both small and large vessels including the thoracic and abdominal aorta, carotid, common iliac, pulmonary, coronary, subclavian, peripheral arteries and occasionally involves multiple vessels. We experienced a 40-year-old male patient with Bdhcet's disease presented with recurrent, multiple aneurysms of right subclavian artery, innominate artery and left radial artery. We present here an unusual case with a brief review of the literatures and the other case reports of Bdhcet's disease with multiple aneurysms in Korea.

The Effect of Cognitive Deficit on Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: To investigate the functional outcome with regard to cognitive deficits in patients with aneurysmal subarachnoid hemorrhage (SAH). METHOD: Two hundred thirty-four patients who underwent surgical procedure for aneurysmal SAH were enrolled. Medical records of the patients were reviewed. RESULTS: Mental confusion (52.1%) was more common symptom than the motor (20.3%) and language (30.9%) impairment in patients with aneurysmal SAH. Neurological grade at admission (Hunt and Hess grade), cerebral vasospasm, and mental confusion were major prognostic factors. In terms of functional outcome, patients with mental confusion showed lower Functional Independence Measure (FIM) scores at admission and on discharge, lower FIM gain and FIM efficiency, and longer hospital stay with statistical significance than those without confusion. CONCLUSION: The patients with cognitive deficits achieved poor functional outcome in the patients with aneurysmal SAH. More attention to cognitive impairment is necessary to achieve better rehabilitation goal.

Surgical treatment of ruptured cerebral arterial aneurysm

A retrospective study on 14 case of ruptured cerebral cranial carotid aneurysm operated in Viet Duc Hospital during 1998 - 2000 has shown that the clinical outcome and method of operation found well in 78.6% of patients. The time for operation was usually late (often 2-3 weeks of bleeding).

Posterior Approach to the Posterior Tibial Artery in Popliteal Arterial Aneurysm Repair: A case report

Surgical approach to the popliteal arterial aneurysm involves medial and posterior approaches. Posterior approach does not need division of hamstring muscle tendons and gastrocnemius head, which is necessary in medial approach for exposure of the entire popliteal artery (PA). Further, it has the advantage of harvesting the lesser saphenous vein without the need of additional incision. Posterior approach to vessels below PA was reported to be effective for bypass from PA to crural vessels in patients with limb ischemia. We report a case of popliteal aneurysm approached posteriorly. A 49-year-old male patient presented with a left popliteal mass and calf claudication for 2 years. Preoperative ultrasonography, MRI and angiography showed a thrombosed popliteal aneurysm. With the patient in left lateral position, the popliteal arterial aneurysm was exposed posteriorly, the lesser saphenous vein was harvested, the crural vessels were exposed by division of gastrocnemius and soleus muscles, and exclusion of the aneurysm and bypass from proximal PA to posterior tibial artery was done. Postoperatively, the patient experienced mild leg edema which soon disappeared, and he was discharged on the 23rd postoperative day. We found the posterior approach to the popliteal and proximal tibial artery to be simple and effective.

A Case of Systemic Fibromuscular Dysplasia with Renovascular Hypertension and Superior Mesenteric Arterial Aneurysm

No abstract available.

Selective Arterial Embolization of Renal Arteriovenous Fistula and Arterial Aneurysm / 대한비뇨기과학회지

A renal arteriovenous fistula and arterial aneurysm are congenital or acquired in origin. Treatment has consisted of partial or total nephrectomy and ligation of branch artery traditionally. Recently the development of transcatheter arterial embolization technique has afforded a new therapeutic alternative Selective embolization using a embolic agent was found useful in management of arteriovenous fistula and aneurysm. With brief review of literatures, we report 5 cases treated successfully by selective transcatheter embolization.